Treatment training manual

3.19 Treatment failure

Treatment failure is defined in different ways.

Sometimes this relates to the different treatments and monitoring tests that are available in a country.

Virological failure

If viral load never reaches undetectable, or rebounds and becomes detectable, this is called virological failure.

This is when the drugs are not working to suppress the virus.

With virological failure, you will not necessarily feel more ill in the short term.

Clinical failure

This is when you get symptoms (ie other illnesses). It means that the drugs are not stopping you from getting ill. This is called clinical failure.

How to manage treatment failure depends on the choice of alternative drugs that are available in any country.

Managing treatment failure

Before making any decisions about changing treatment it is important to find out why treatment failed.

  • It may be that you have not been taking treatment on time, or in the way prescribed. Or that you have stopped taking treatment altogether.
  • It may be because of drug resistance. Or because the treatment was not potent enough. Or because the drugs were being poorly absorbed.

Management of treatment failure is different depending on which country you live in. This is related to whether viral load tests are easily available..

  • Virological failure is used to decide when to change ART in high-income countries. This is when there is access to viral load tests and/or there are several options for a new combination.
  • Clinical failure is used to decide when to change treatment in many low- and middle-income countries (LMICs). This is when viral load tests are not available and/or there are limited options for a new combination.

When there are new treatment options, then changing all three drugs to a new combination is recommended.

Low level increases in viral load (up to 2,000 copies/mL) are often just blips (one-off unusual results) and often go down by themselves.

Blips do not count as treatment failure.

Blip compared to viral rebound

Virological failure usually occurs first. It can sometimes take months for this to lead to clinical failure.

Management of treatment failure is a specialised area, and approaches changes based on new research.

Further reading

i-Base produce a detailed guide to changing treatment.

This is a separate resource to the advocacy manual and is based on virological failure. It has been translated into other languages.

Last updated: 1 January 2016.